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Why Metrics Matter

December 12, 2013

An internal Health and Human Services (HHS) memo, dated September 5, 2013, listed the Administration’s projected Obamacare enrollment targets at 494,620 for October and 3.3 million by December 31. On the eve of’s launch, HHS Secretary Kathleen Sebelius upped the ante, setting seven million sign-ups by the end of March as what “success looks like.”

Sebelius defines Obamacare success

So what are Obamacare’s successful enrollment rates? According to HHS’ October report, only 106,185 people signed up for health insurance that month – 26,794 through and 79,291 through state based exchanges. Yesterday, HHS updated its figures to include November’s data. The Administration’s report claims a total of 364,682 people (258,497 during the month of November) signed up in the exchanges – 137,204 through and 227,478 through the state exchanges.

Success vs reality

Clearly, the Obama Administration failed to hit its targets. Even these new figures should be read skeptically. Almost immediately, three caveats leap off the page:

  1. Duplicate Numbers. The HHS report concedes that some state exchanges are attempting to correct data problems that may have resulted in HHS double counting certain signups. This is not an insignificant figure. Approximately 62 percent of Obamacare’s total signups are derived from the 14 state based exchanges. The HHS report claims that’s signup data did not contain duplicates.
  1. Sign-Ups Don’t Equal Enrollments. The Obama Administration counts people as “enrolled” in Obamacare if they successfully selected a health insurance plan. It is unclear, however, exactly how the Obama Administration defines “selected a plan.” Are these people who completed the application, chose a plan, and paid the first month’s premium? Or are these people who completed the application, chose a plan and put that plan in an online shopping cart, but have yet to pay the premium? Until individuals pay the first month’s health insurance premium, they are not deemed to have coverage. No one knows – because the White House refuses to say – exactly how many people who successfully completed the application process have failed to pay the insurance company the first month’s premium. This is a very important metric. Americans who do not pay will show up at their doctor’s office in January and discover their coverage isn’t valid. According to reports, some insurers estimate only five to 15 percent of people who selected an Obamacare health plan have paid the first month’s premium. One industry consultant said, “a plan will be lucky if half of applicants pay [the] first month’s premium on time for January coverage start.” This means the Administration’s suspect enrollment numbers could fall in the coming months.   
  1. “Visits” Data Can’t Hide Substandard Enrollment Numbers. Attempting to mask’s lackluster user capacity, the Obama Administration continues to tout the total number of visits the website generates. In yesterday’s report, HHS proudly announced both the state and federal exchanges garnered 39.1 million site visitors. But there is a big difference between the total number of site visits and the total number of people using the application technology to enroll in a health care plan. The Administration’s data imply that most people visiting may not actually be applying for insurance, but simply looking for basic information.

Health Care Headlines

Wall Street Journal: Opinion: “Juking the ObamaCare Stats” Most of Washington seems to have bought the White House claim that the 36 federal exchanges are finally working. But if that’s really true, then what explains the ongoing secrecy and evasion? On Wednesday HHS allowed a glimpse into the Affordable Care Act’s “enrollment” for November. Out of respect for a free press, reporters ought to boycott these releases because they're so selective that they reveal little about real enrollment.

CBS News: “Issa alleges ‘criminal obstruction’ of oversight probe by HHS” House Oversight Committee Chairman Darrell Issa, R-Calif., is accusing HHS Secretary Sebelius of committing “criminal obstruction” of a congressional investigation by instructing contractors working on the site not to provide documents to Congress.

CNBC: “Cancer patient: I’m devastated over Obamacare” Joan Carrico, a 60-year old registered nurse who has been fighting cancer for the past six years, liked her insurance policy but unexpectedly received a cancellation notice. Like many Americans, she had trouble logging on to the website. Since then, the President has granted a one-year extension for those who received cancellation notices and the website has improved – but there's still a lot to sort out.

CBS News: “Employment prospects dim over Obamacare” may be functioning better, but consumer and corporate acceptance of Obamacare may continue to bedevil the law. A Duke University/CFO Magazine survey of corporate finance chiefs found that a significant percentage of companies will hold back on hiring full-time workers because of the Affordable Care Act.